-How prepared is Nevada for a possible influx of out-of-state patients seeking abortions?

That's this week on Nevada Week.

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Welcome to Nevada Week.

I'm Amber Renee Dixon.

Several states have already banned abortion following the US Supreme Court overturning Roe vs. Wade.

Meanwhile, several other states are set to ban the procedure or restrict it with three of those states neighboring Nevada.

Women can still access abortions in Nevada where abortion is legal within 24 weeks of pregnancy and after 24 weeks if the pregnancy endangers the patient's life or gravely impairs the patient's physical or mental health.

As a result, organizations like Planned Parenthood say Nevada should expect an increase in out-of-state patients looking to receive abortions here.

There are reportedly nine clinics in Nevada that provide abortions, seven in Southern Nevada and two in Reno.

So will that be enough to handle an increase in volume, and how might the routine prenatal care of Southern Nevadans be impacted?

Joining us now are Dr. Anna Contomitros, an Obstetrician-Gynecologist at Woman to Woman Gynecology; and Dr. Joseph Adasheck, Perinatologist at Desert Perinatal Associates.

Thank you both so much for being here.

Dr. Anna, you are wearing a mask today.

And I want you to explain to the viewers the two reasons why you are.

(Dr. Contomitros) Yes.

I am wearing a mask because I am scared.

I'm scared of two things: I'm scared of COVID, and I'm scared of violence.

Because in my practice we see patients who can potentially have COVID, I need to be healthy to take care of them.

And I wear my mask because I'm scared because violence, unfortunately, is directed at doctors who provide abortion care.

So I would like to hide my features to decrease the chance of being recognized.

-What have you seen at your practice following the overturning of Roe vs. Wade?

-Within a day.

The overturning happened on Friday the 24th, I believe, of June.

And on Monday, which was our first day back at work, we had two events happen that really truly scared me.

I arrived at work at eight o'clock in the morning, and my manager came to me and she said, "Good morning.

The FBI is here."

So my heart skipped a few beats.

And we went to talk to them, and we heard that they were making a preemptive visit to our facility.

And the reason why they were doing this is because there is a concern from the FBI about increase in violence in facilities and against doctors who provide abortion care in the states where they still provide abortion, medical health.

And so we were very concerned about that.

And then we started work, and then less than a few hours later, a gentleman called and wanted to set up an appointment with me to ask me why I wanted to kill babies.

-So that's one experience.

But as far as increase in requests, are you seeing more people calling your office to schedule?

-Of course.

We see a much higher number of calls and a much higher number of patients coming from out of state.

For example, states like Texas, Arizona, Utah, and even more distant states like West Virginia, Ohio.

Many patients use our hospitality in Nevada to hide the reasons why they come into Nevada.

So they are coming here for medical care, but they're coming under the auspices of traveling to Nevada for fun.

-That is the reason they are telling people that they're coming here?

-Exactly.

-In Texas, it was last year when they implemented the six-week ban.

Did you immediately feel the impact after that?

-Yes.

We had patients come from Texas, travel.

Many of them stayed for just a day.

They came early in the morning--they went home late that afternoon after their procedures-- and we had to do both pregnancy termination by pill and by surgery because these patients were beyond the six-week cutoff.

-I want to ask you more about that, but I want to get to Dr. Adashek.

You are also a local representative with the American Medical Association.

From that perspective and what you know of the Las Vegas Valley, how prepared do you think Nevada is for this potential influx?

And what are the possible repercussions for pregnant woman seeking regular prenatal care?

-Well, I also was president of Clark County Medical Society and during the shootings of One October, and now an AMA delegate.

And to start with, what's been fortunate is the American Medical Association has come out with a statement saying that providing abortion is a typical medical care procedure and to be offered without any restrictions.

And the American Congress of Obstetricians and Gynecologists also has come out with a statement, and Nevada State Medical Association.

So we have all these medical groups that have come out with a statement saying it should be typical normal care provided by physicians.

Our office-- I'll get back to your question in a second.

We're just high-risk pregnancy specialists only.

So we get the cases where we do terminations of pregnancy to save the mom's life.

Many times that's the reason or unfortunately, we see a lot of patients with babies with lethal birth defects.

They tend to be a little bit later, probably.

Dr. Anna sees them, but 20 or 22 weeks where they find out that the baby has lethal or near-lethal birth defects.

No head, which is anencephaly or some very terrible birth defects.

And by the way, none of these patients expect at the beginning of the pregnancy that they will be talking about termination of pregnancy at 20 weeks.

It's just never really even a thought in their head.

In terms of patients coming to Las Vegas, I don't think we're prepared at all for the influx of all of those patients.

The clinics that provide abortion care are already pretty busy and pretty crowded, and our practice has certainly gotten phone calls for quite a while now from Utah and Arizona who patients find out at 20 weeks is lethal birth defects that want to come see me (a) for a second opinion on the diagnosis, and then (b) if it's really true to have an abortion performed.

-Dr. Anna, when you are taking calls from patients, how do you prioritize who gets to come in first?

Because you also, in addition to providing abortions, you provide regular OB/GYN care.

-When a woman calls and she wants to terminate a pregnancy, this is an emergency.

It's very much like finding a lump in your breast.

These patients are seen immediately because time is critical and every day counts.

So every day can make a woman go from what would be an easy pregnancy termination by pills to a more complicated pregnancy termination by surgery.

So we give patients an appointment within 24 hours.

-How do they get here within that amount of time?

-If they are local, they can do so.

But if they are out of state, the next thing that they do is they book their appointment at a hotel and then they get onto the next flight.

And they come the next flight, or they come the night before their appointment.

And then they have their procedure, they have their evaluation, then they go home that same day.

Many patients don't want to take time away from their lives and their work and from their children.

So their visit to Las Vegas is very short because they need the care and to be gone.

-That sounds very dangerous.

-Well, what happens is that when you have medical pregnancy termination, the majority of the pregnancy termination happens at home whether they are locally in Las Vegas or they are in Texas for example.

They will do the miscarriage at home.

In our office, we offer the pregnancy termination by pill up to nine weeks, but it can go as high as 10 weeks.

But we have to be very judicious about the type of patients we offer this to because many patients may have clotting conditions, may have abnormalities in their uterus, may have prior cesarean sections, all of which increases their risk of having bleeding after the procedure.

So we do send them home with special medication.

They have my own on personal phone.

They call me in the middle of the night, and I tell them what to do and what not to do.

In fact, we had a patient who had a pregnancy termination who went back home to Texas and was experiencing very heavy bleeding.

She was getting ready to go to the emergency room, and I warned her not to go because it was the week before that a woman was arrested for having a pregnancy termination by pills in her own state.

She did well.

The following day the bleeding had diminished.

She took the medication that we sent her home with, and she was safe.

But not being able to have-- Not been able to tell the truth about your medical care puts you at even a worse risk because you go to your doctor, you want to say, I've taken this medication, this medication, and I have an allergy to this one.

And if you actually divulge this information in a state that doesn't support abortion care, you're castigated.

-Well, let's keep this nonpolitical, please.

I just want to talk about the impact of health care here in Nevada.

And when you do talk about the different associations that have come out with statements and talking about abortion being health care, the pro-life side would say abortion is not health care and that this is about saving someone's life and that's what doctors should be focused on.

But again, the health care aspect.

So talking about the doctor shortage in Nevada, how prevalent is it?

And will the prenatal care of a regular woman who is pregnant be impacted if doctors are overloaded with abortion appointments?

-Oh, without a doubt.

I mean, I think Nevada is like 49th in the country for the amount of doctors per population.

So we're not just shorthanded because the population is small in the state.

Our practice, to try to find a high-risk pregnancy specialist to join us, there is no fellowship for maternal-fetal medicine in the state of Nevada.

So they all have to come from somewhere else.

So the problem is that in terms of financially offering them a reason to move to Nevada is difficult because Nevada is 49th in the country for a reason.

Because, you know, Medicaid and other insurance companies decide that they really don't want to pay doctors what other states do.

And doctors have families, and they will tend to go where they financially could do the best, just like anyone and any other job.

But Nevada is especially bad for graduate medical education.

In other words, you go to medical school for four years, and there's not a lot of residency positions open for OB/GYNs.

And then in my field you have four years of OB/GYN residency and then three more years of fellowship.

So that's seven years after medical school.

And it's hard to find people to come here.

-Dr. Anna, when you are making these appointments and you're prioritizing someone who needs an abortion, are you having to reschedule other clients or turn other clients away for the routine care?

-My practice sees patients at all times of all types.

Yesterday, for example, we were exceedingly busy.

So patients had to wait longer, and they were frustrated, especially wellness checkups.

So because we do have the potential of increasing our hours, we are now going to segregate patients.

So patients who have routine medical care or routine gynecology are going to be seen on specialty days, and patients who needed to have abortion care will be seen on different days.

In this way, we will try to be more efficient in seeing patients who come for a minor problem or their wellness exam, rather than taking care of them both at the same time with women who have abortion care because they are very special patients.

They require a lot of emotional support and a lot of hand holding.

-How long can you sustain that?

-I hope God helps me and makes me sustain this for as long as it is needed, until we can reverse this decision, until we can allow women to have the health care they deserve.

-Thank you so much.

I did want to add one note before we wrap this up, and that is that the Nevada Governor, Democratic Governor Steve Sisolak, did sign an executive order on Tuesday that is protecting doctors in Nevada who provide abortions from prosecution, as well as extradition if someone from another state was to try to prosecute you or get you moved to that state, as well as protections for out-of-state patients who are seeking abortions in Nevada.

Dr. Anna Contomitros, thank you so much for joining us, as well as Dr. Joseph Adashek.

In 1990 is when nearly two-thirds of Nevada voters approved a ballot measure to ratify into state law the right to a legal abortion within 24 weeks of pregnancy.

This right can only be repealed or changed with another direct vote of the people.

So can we expect abortion rights to be a major campaign talking point and influence voting in Nevada's midterm elections?

Here to discuss that and more surrounding state politics are Jessica Hill, political reporter for the Las Vegas Sun, and Jacob Solis, who covers politics and higher education for The Nevada Independent.

Thank you both for being here.

Jessica, in an article that you wrote, you quoted Nevada Democratic Representative Susie Lee.

This was prior to Roe vs. Wade being overturned, and she had said Nevada will be a sanctuary state for abortions, and the increase in women coming here for an abortion will overburden an already overburdened healthcare system.

Have you heard any response to that concern from Republicans?

(Jessica Hill) Honestly, we haven't heard a whole lot from Republicans on that side of things.

Most of the time-- Most of the Republicans that we've talked to have mentioned how, We'll go with what Nevadans want.

They recognize the statute, and they recognize that abortion is legal here.

They haven't so much commented on the specifics and the nitty-gritty about the healthcare system.

-Have either of you noticed an appetite from the conservative or the Republican side to try and have another voter referendum that would change or repeal the law currently in place in our state?

(Jacob Solis) I would categorize it maybe as murmurings about another referendum.

The thing is, is that it's a risk that you risk mobilizing the base who is motivated to vote on something like abortion as an issue, and it costs money.

You can't simply run a referendum.

You need to get the signatures to get it on the ballot, and then you need to mount a campaign to get it passed.

And abortion is a tricky issue, and it's something that's difficult to message even for those who are antiabortion and for those who are proabortion.

So it's kind of a third rail that everyone is a little wary about touching.

And I think that's why you've seen that kind of trepidatious messaging from Republicans on this.

-Has it been like that?

-Yeah.

Many Republicans, I think.

I agree with you with that.

I know Congressman Mark Amodei was saying he knows that Nevadans support abortion here, and he doesn't really seem to have any plans to really push anything forward.

He might support or vote to approve certain measures to restrict abortion; however, he understands that Nevadans overwhelmingly support Roe v. Wade and abortion access.

-So do they take that same mindset into a potential Federal ban on abortion, which would supersede Nevada law?

Any talks that you've heard of that?

-A lot of the Republicans that I've talked to have been pretty quiet about really making any sort of promise on that.

I know that Adam Laxalt has mentioned, I think to the Review Journal, that he would support a national ban or some sort of referendum on a national level, I believe; is that correct?

-That's a race-- -Yeah.

At least on a state level, Adam Laxalt has signaled interest in another referendum to at least look at the Nevada law.

But what's interesting, I think, about abortion specifically in the way that the Supreme Court ruled, is that it's been made into a states' rights issue, right?

Essentially, it should be up to the states to decide what they want to do.

And that sort of butts against this Republican push for a national abortion ban.

And so they have to balance those two messages.

And I think that it's not quite clear what the Republicans as a party would want to do on that.

-So then with that in mind, I would ask you about Democratic Senator Catherine Cortez Masto, who's running against Adam Laxalt, who was quoted as saying, "That race is going to determine the future of women's reproductive rights in Ne vada and across the country."

How accurate is that statement?

-In a way it is because certainly the Republicans have made their stance on reproductive issues.

It's abundantly clear.

It may be at a point though that the decision has been made by the Supreme Court, right?

There's no putting the genie back in the bottle here.

And so to an extent, I think what matters is like you say that possible national ban on abortion that could come from Congress and whether the Supreme Court would strike that down, presumably not based on the current composition.

So in that sense, I think that's what she's referring to.

But really where we are right now, the landscape is state by state.

-How hard do you expect Nevada politicians to discuss abortion in the lead-up to the midterms?

-I think the Democrats in Nevada are really going to use the abortion topic leading up to November.

I don't know how big of a role it will play come November.

You know right now it's on the minds of everybody.

But in just a few months, how big of an issue will it be?

There was a poll, from I think it was USA Today in Suffolk University, that basically said-- This was before Roe v. Wade was overturned, but they asked the biggest issues that are important to them, and the economy was still number one.

And I think it was like 7 in 10 respondents said that the Roe v. Wade decision would not affect their decision whether or not to vote in November.

-So if Democrats are going to push that issue, does it make them appear that they're not listening to the issues that voters are actually talking about with the economy, with inflation, with high gas prices?

Is there a risk there?

-I think the real risk is that if Democrats want a message on abortion, they have to do something about it in Congress.

And if that doesn't happen, how mobilizing of an issue is it for voters who might already be upset the Democrats aren't delivering when they control the levers of power already?

-There are a lot of criticisms that the Democrats had so many opportunities since the '70s to codify Roe v. Wade, and they just never maybe thought that it would be an issue, that it would never get overturned.

But a lot of people are criticizing them for not doing anything in the interim.

-I want to move on to the Nevada Republican Party and its Chairman Michael McDonald.

What has been going on with him-- cell phone seized by the FBI, a subpoena by the House Select Committee for January 6th.

What is the latest?

-So we don't know exactly the latest.

But we do know that, yes-- -Because he's not talking.

-He's not talking to us.

I've gone to the Republican Party headquarters, and he has not been there.

He won't answer any emails or phone calls.

But he and James DeGraffenried were both subpoenaed by the Justice Department.

And before this, I think it was in January they were subpoenaed and asked to come into the January 6 committee.

And they have not complied, along with many other Republicans who have not complied.

So it'll be interesting to see what happens with that and how long it will take to get more news about that.

-What do you believe they are looking for on that cell phone?

-Well, I think they're looking for evidence that there was a coordinated effort around these sort of fake electors that they were trying to use to justify that Trump was legally the President post the 2020 election.

If they can find, I think, that level of coordination from maybe state level Republicans and national level Republicans, I would assume that that's what they're looking for to mount some sort of broader case that it was, again, a coordinated effort.

-And the last time we had you on was after the primaries.

And we talked about how interesting it is that when Joey Gilbert, who ran for the Republican primary for Governor, lost and is claiming election fraud still to this day, Michael McDonald of his party saying, we don't want to hear those claims, or we don't think there was any fraud.

Now that this comes around and he's being, you know, questioned, what kind of light does it paint on the Republican Party in Nevada?

-Yeah.

I think some could look at it and see a little bit of irony.

When Joey Gilbert came out with those claims, Michael McDonald said he was disappointed and he doesn't understand where they're coming from and his job is to unite the Republican Party.

However, just a couple of years ago, one could argue that he was not uniting the Republican Party when there was a split between those who believed in election fraud and those who didn't.

And so now that's just coming back to light again with these further investigations into his activities on January 6 and leading up to that with a fake elector scheme.

-Do we know what comes next for Michael McDonald?

-That's an excellent question.

The Republican Party in Nevada, I think, was diminished sort of post-2014.

It reached that apex in those elections, and then in 2016, 2018, and 2020, I think has struggled to win elections in Nevada.

I think that's the most relevant part of this thing for Michael McDonald is that he's trying to win elections here, and the Republican Party so far hasn't done that.

In the broader scheme, does the January 6 committee continue to go after this fake elector scheme?

Most likely; and in that context, I think we really have no idea what might happen next.

-But the Republican Party appears pretty strong in Nevada at the moment, right?

-That is true.

Yes.

-Mm-hmm.

2022 is a different area.

-And Chairman McDonald has been here for a long time.

There have been other complaints about him that haven't gotten anywhere.

So who's to say if he would go anywhere at this point.

-And back to Joey Gilbert, the latest with him and his recount that he wants.

What is going on?

-Yes.

He's going to pay I think about $190,000 to recount in all 17 counties in Nevada.

He is claiming that there's proof of election fraud, and that they will undercover it.

There was a live stream just a couple of days ago with him and a kind of election denier named Robert Beadles.

And they're saying that they know that the recount won't end well for them because they're using the same voting machines that took place during the election.

They understand that they'll lose the recount; however, the next step will be to go to court and to counter those results.

-So paying for a recount that he already thinks is not going to work.

-Right.

-That is interesting.

-And it's by 26,000 votes that he lost.

-Right, 11 percentage points.

Is that battle worth it?

We will find out, and perhaps the attorney from Reno will be mounting a lawsuit, as you mentioned.

Both of you, thank you so much for joining us.

And thank you for joining us for Nevada Week.

For any of the resources that we discussed here, go to our website, vegaspbs.org/nevadaweek, and you can follow us on Facebook and Twitter @VegasPBS.

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